Facial neuralgia

Summary When confronted with a case of facial neuralgia, and if this is seated on the right and there is an absence of other indications, there is a strong chance that the remedy will be Kalmia latifolia. If it is seated on the left and the eyeball is affected, the remedy is Spigelia. If the pain is of the electrical discharge type and seated at the level of the left upper lip, or else of the lower left gum, the remedy is Colocynthis. When the pain appears gradually and disappears slowly, whether seated on the right or on the left, the remedy is Stannum. If the pain is aggravated by draughts, think of Nux vomica. If it is aggravated by the cold, think of Silicea. Sulphur and Calcarea carbonica are the two remedies for facial neuralgia which are at the same time the constitutional remedy for the patient, an exception to the rule which says that facial neuralgia is never treated constitutionally. Facial pain of vascular ogirin, on the other hand, is treated constitutionally, like migraine (Sepia, Aurum, Pulsatilla).

symptomatology, so that it may be compared with that given by Hering in his celebrated Guiding Symptoms and that given by Lilienthal in his treatise on therapeutics.

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Three remedies, Kalmia latifolia, Spigelia and Colocynthis, covered 56.2 pet' cent. of the cases, and five--adding Stannum and Silicea--74.8, or almost 75 per cent. The remaining remedies appear important in view of the small number of cases analysed.

KALMIA LATIFOLIA
A long time was spent searching for the Kalmia latifolia key-symptom before it was realized that, where neuralgia is concerned, the key is given by the area affected. In cases of facial neuralgia, if no other dominant characteristic is found, the fact that the neuralgia is on the right side is sufficient to prescribe Kalmia latifolia. For other neuralgias, the Kalmia latifolia keynotes are more precise: in cervieobrachial neuralgia, for example, if the pain is short and sharp {shooting pain) and in the direction of the hand, the remedy is Kalmia latifolia.
If the pain spreads to the little finger {aurieularis, 5th finger) the remedy is Kalmia. If the pain affects '% large part of a limb" (Boericke), the remedy is again Kalmia. These indications are certain and are confirmed daily. On the other hand, pain which shoots along the sciatic nerve indicates Colocynthis and not Kalmia. If the pain shoots along the crural nerve, the remedy is Staphisagria. The importance of the area affected can thus be seen. Boger well understood the importance of the area affected. Below are some symptoms which seem fairly characteristic and which will help in determining whether to use Kalmia if there is a doubt about laterality as such. They are in so way obligatory.
There will be a host of symptoms and modalities which are not among the guiding symptoms (because they are not characteristic: a modality is not necessarily characteristic) and many of the symptoms listed in Lilienthal were not encountered. Do not then make undue efforts to look for all the symptoms and, even more, all the characteristics. One must try to decide on the dominant characteristic which, allied with the essence or the general effect of the remedy, will allow effective prescription. If, in ignorance, this dominant characteristic is overlooked, do not imagine that it will still be possible to discover the right remedy by multiplying the questions, the minor symptoms, the lesser modalities. Beginners tend to attach immense importance to one modality--one which is in general easily apparent, for instance aggravation by least touch, and thus limit themselves to a very small number of remedies. Boger says that "what often makes a cure hard is laying too much stress upon some particular factor at the expense of the disease picture as a whole, thus destroying its symmetry and forming a distorted conception of the natural image of the sickness". Kent also pointed to this danger in a personal letter addressed to Dr. Tyler which was recently republished in The Sandesh Homoeopathic. It is important to note that the dominant characteristic symptom need not necessarily be a mental symptom.
Kalmia is a difficult remedy to handle and sometimes needs to be repeated, or complemented by another remedy. The premature repetition of a remedy, when treating neuralgia, always provokes an aggravation of the pain which may last as long as two, or even three weeks! In all cases of neuralgia, we give a single dose and allow it to act for a month. This is the general rule. In the special case of Kalmia, the remedy sometimes has to be repeated after 8 months. Even then, haunted as I am by the possibility of aggravation, the case is always thoroughly re-examined before the dose is repeated. Kalmia is the remedy which gives the greatest number of aggravation reactions on first prescription (4 cases out of 9). In view of this, the potency should not be increased. Four cases out of 9 were healed in a few days with a single dose, and 4 cases by 2 doses given at intervals of from 4 months to 2 years. In one case, it was necessary to complement the remedy with Colocynthis and then Silicea. One year after giving Kalmia, the pain had passed over to the left side, at the level of the upper lip, with sensations resembling electric shocks.
Colocynthis was prescribed. Several months later, the pain, relieved by heat, had passed over to the right side again. A dose of Silicea put an end to the complaint. It should be noted that Coperthwaite prescribed tincture of Kalmia. In view of the frequent aggravation reactions, it is worth trying tincture of Kalmia. Coperthwaite was very conversant with this remedy, and we owe its right laterality to him.

SPIGELIA
The dominant characteristic is facial neuralgia with the pain on the left and the eyeball affected. Given this indication, I have never known any setbacks and all my patients have been cured with a single dose.
In one of the 5 eases, Spigelie had to be complemented with Lac caninum.
One year after the single dose of Spigelia, which had done a lot of good, the pain had passed over to the right and then again back to the left. A second dose of Spigelia proved ineffective, and the condition responded to a single dose of Lac caninum.
In another case, Spigelia was used to complement Lycopodium. The pain began on the right and regularly passed over to the left. The dose of Lycopodium gave very good results over a period of one year. The following year the patient complained of pain on the left side, affecting the eyeball. One dose of Spigelia cured the condition. Pain associated with Spigelia starts in the morning and increases with the progress of the sun, decreasing in the evening, always with the sun. One reads of this in the materia medicas. In practice, it is not always possible to get such a precise indication. In two cases out of five, the pain started every morning. In one case, it was actually less in the morning, and in one case it was aggravated every night. It was not possible to verify the keynote on which Lilienthal was so insistent: trigeminal neuralgia preceded by palpitations. Incidentally, Spigelia is an excellent remedy for Arnold's neuralgia, located on the left. The pain starts in the left cervical region and spreads forward to the parietal region, ending up in the frontal region above the eye, although the eyeball is not necessarily affected. It is also a good remedy for migraine, in cases of left hemicrania, since it is not always easy to differentiate diagnostically between a case of migraine and one of neuralgia. COLOCYNTIIIS This is an old, well-loved friend which has never disappointed. In hospital, when I started practising, each time my duties brought me face to face with a patient suffering from colic and sitting in bed "clutching his pillow"--which we called among ourselves "the pillow syndrome"--a dose of Colocynthis was prescribed and the effect was spectacular. Later, this old friend continued to obtain satisfaction for me in many different ways. I perceived that in cases of low back pain, where the patient presented with intermittent, shooting pain, "like a knife thrust" in the patient's own words, with or without movement, the remedy was not Bryonia but Colocynthis. It never failed and 4 per cent. of cases of low back pain responded to Colocynthis. This remedy, which never needs to be repeated, must be given time to work. In general, a positive effect is apparent after about 3 or 4 days but, in certain serious cases, the dose must be left to work for 3 months before the patient feels no more pain in his back.
There is another remedy, Sulphur, which presents with this type of pain.
But the pain itself is not so intense but rather of the intermittent lancinating type. With Colocynthis, there is a single violent attack which only recurs from time to time. The pain associated with Colocynthis is shooting, like a flash of lightning or an electrical discharge, whether it be in the lumbar region, at the level of the sciatic nerve or at that of the trigeminal nerve. In the face, the pain is on the left, at the level of the upper lip, and the patient describes it as being like an electrical discharge. The effect, too, is very spectacular, like lightning.
I had 4 cases of Colocynthis out of the 33, that is 12.5 per cent. Two patients were cured with a single dose. In one case, it had to be complemented with Kalmia latifolia and then Silicea, the pain having changed sides (passed over to the right). In one case, 3 doses of Silicea had to be given at intervals of

STANNUM
The following is the dominant characteristic. The pain begins gradually a~d ends slowly. All Stannum eases (4) were cured with a single dose. Stannum was prescribed once for an Iodum subject whose spastic colon had been cured with this remedy. Pain associated with Stanuum can be on the right oc the left, and attacks recur several times during the day. In Stanuum eases, the locality of the pain is of :no importance.

Roberts used this as a model of repertorization in his introduction to
Boenninghausen's Repertory. Two cases. In one case, it served very effectively as an "intercurrent remedy" with Silicea. In the other case, it was also the constitutional remedy (as is Calcarea carboniea). Sulphur is very closely related to Bacillinum, frequently used by Burnett. In the early days of my practice, it was used as a specific for facial neuralgia and many setbacks were experienced. My mini-statistics seem to show that there is no specific remedy for every condition. When Sulphur is not the right remedy, it may give rise to considerable aggravations lasting as long as 2 or 3 weeks. A detailed symptomatology of the remedies used is given below.

KALMIA LATIFOLIA
Facial neuralgia on the right side (9 cases) Pain in the right eye (3 cases) beneath the eye and nasal cavity Right (superciliary) arch Nuchalgia Increase in intraoeular tension (2 cases) Veil, unable to see out of this eye Feeling that the eye is being torn out (2 cases) Very strong shooting or stabbing pain8 in the eye (3 cases), provoking nausea Reddening of the eye (2 cases) Lachrymation (4 cases) Unilateral rhinorrhoea (2 cases) A very special pain, unlike any other, which greatly tires, shocks, the whole area painful, always on the right and inducing sneezing (2 cases) A piercing sensation in the temple Throbbing (2 cases) Sensation of a draught blowing in the temple and penetrating the brain Burning sensation (2 cases) pins and needles numbness of painful side of the face Facial swelling Eyelid slightly red and swollen (2 cases) Great facial heat (2 cases), puts on cold compresses A feeling that one eye is closed more than the other Very severe attacks, particularly in the spring and autumn Very intense pain, inducing thoughts of suicide Pain like an electric current Twinges in the back of the head, then in the front; pain bad enough to make the patient cry out aloud, inducing vomiting Attacks at almost any time of the day An attack lasting from half an hour to several hours Attacks occurring over a period of a month and a half May be free from attacks for two weeks, then attacks every day Sudden onset Starts gradually; ends gradually (Stannum) Starts suddenly; ends suddenly Attack may last for no more than a few minutes Aroused by the pain at night Hourly attacks Dreads going to bed Aggravated in the morning on waking Aggravated by the slightest draught Aggravated by strong sun Aggravated by thinking about it, concentrating on it Aggravated at the slightest touch, unable to wash the face with a flannel in the morning Aggravated by blowing the nose Aggravated by coffee Aggravated at mealtimes Aggravated by talking The pain starts in a tooth, spreading to the temple and communicated to the nape of the neck Neck very stiff, like torticollis Night perspiration in the region of the neck Aggravated every morning (2 cases out of 4) Aggravated every night and ameliorated in the morning, on waking (1 ease Pain beginning in the jaw and spreading to the temple Pain located on the left superciliary arch and all round the eye the eye is red; watering; but no pain in the eye; 2 to 4 attacks a day, every day; the attacks last from 5 to 45 minutes; like extremely hot water trickling down the temple; during the attack, a feeling of compression; Pain is always seated on the right (one case) Right side becomes red and painful Attacks every day, at the beginning of the afternoon, or the evening: one hour after meals Feels like a knife-thrust in a tooth; as if something very painful is being driven in Pain appears gradually and disappears slowly (in all cases) Pain disappears from the jaw when it reaches the temple In a case of spastic colon of the Iodum-k -k -]-type SILICEA Pain is seated on the right (3 eases) Pain is seated in the lower maxillary (2 cases) Right side (painful side) of the tongue does not feel the cold nor the heat (keynote) Intermittent pain Pain as if the patient had received a box on the jaw tenderness with lack of sensation Modalities: draughts and the cold make the patient wince and bring on the pain (4 cases In a Natrum sulphur asthmatic-~ ~ -~ Pain is seated on the right Pain is seated on the left (arches, cheekbone, under the eyes; the ali nasi) Burning sensation Slight swelling Aggravated by the least touch Aggravated in the morning Aggravated in hot weather Aggravated by draughts (not cold at all) (characteristic) Pain spreads to the front haft of the breast Concomitants: (important with Nux) pain in the region of the gall bladder Patient becomes light-headed if he eats more than usual Flushes in the morning CHELIDONIUM Pain seated in the right superciliary arch (in all cases) Pain behind the right eye, extending to the back of the head Redness of eye Lachrymation Continual pain with paroxysms Really violent pain Pain not at all pulsating Irritating pain Pain which freezes the neck Pain at 4 to 5 p.m. Pain on waking in the morning Pain in the night which rouses (2 cases) Pain starts gradually, but very rapidly, and ends gradually Myopia of the right eye The eye is obscured by a veil before the attack, once only Aggravated by reverberation Unilateral rhinorrhoea Subject is anxious and restless CALCAREA CARBONICA Pain seated on the right, in the lower jaw (2 cases) Pain ascends vertically Pain in the region of the right upper lip (Colocynthis on the left) in sudden knife-thrusts, very violent, making the patient cry out (like Colocynthis, cf. Gelsemium) Mouth twisted during the attack Becomes pale during attacks Aggravated by lying on the painful side Aggravated by opening the mouth (2 cases) Aggravated by talking Aggravated by eating Aggravated by the least touch After a dental extraction Also the constitutional remedy in both cases, corpulent subject, solidly built, perspiring easily from the head, pillow-case wet at night.